These PSA tests do not give “results” and the medical people above have stated. You are neither cleared nor diagnosed from this test. The test only gives an indication. And it’s been determined by people more qualified than some rando on Faux News that the test approaches uselessness beyond around age 70.
I was speaking generally about “extra scans”, not specifically about the PSA test.
What smithsb said.
Another problem with testing specifically, if you are a prominent politcian, is that as soon as voters hear cancer, some will vote against you. You can try to cover it up, but that can make it, politically, worse. It is better to do the tests that are proven helpful, and avoid others, as Biden did.
That’s quite possibly true, but it has nothing to do with medicine.
According to the above, it’s better to never test anything if you’re a politician. This does presume that said politician cares more about being elected than not dying, though.
You can’t cure what isn’t diagnosed.
This implies that the American system applies everywhere - it doesn’t. In Canada, tests are generally done when they are medically required not when demanded by the patient. We spend less per capita on health care but have better outcomes and longer lives in spite of this.
A policy designed for optimal health outcomes per dollar is irrelevant to a president (or CEO). That isn’t to say that all extra scans are medically actionable. Just that a policy where you put money toward the most effective results isn’t going to be the same as what a VIP demands. I’m sure there are many Canadian VIPs that pay extra for a different class of service.
PSA testing is cheap. The reason it isn’t routine in Canada and the UK is that, even in the age band recommended by the U.S. National Cancer Institute, any benefit is so marginal that experts disagree on whether it is a good idea.
There is currently an unprecedented large study going on, in the UK, to see if MRI screening will be helpful. This would cost much more than PSA, but if routine PSA is worthless, the cost effectiveness of routine MRI screening would be infinitely higher.
Biden’s VIP care would properly be meant to assure he got the care per normal U.S. guidance with nothing accidentally missed.
P.S. MRI testing after a high PSA and/or in presence of symptoms and/or with biopsy has been tested before. The new study concerns routine MRI screening.
Again, I wasn’t talking specifically about PSA testing. The sub-thread I responded to was actually about full-body MRI scans. Which may or may not be useful, but regardless, rich folk are getting them.
As best I can tell, the reasoning is just the one that’s been advanced in the thread already: whatever it detects is likely to be so slow-growing that the patient dies of something else first.
Though that suggests a one-size-fits-all cutoff isn’t particularly great. An especially healthy patient that expects to live to 90 might make a different utility calculation.
The results of that should be interesting. Which is actually the main point I was making in my original post: the utility of increased testing isn’t just to the patient but to everyone, because you learn more about which tests are actually useful.
If enrolled in a preventive medicine clinical trial, I would agree.
If I was the President, I would task the White House physician to find a preventive medicine trial for me to join. Biden did not do that. So I doubt he got anything much different from the U.S. official guidance standard of care.
That’s part of it. Another part is that it’s more likely to be slow-growing because testosterone levels tend to be lower as men age.
Anyway, when i first heard about Biden’s cancer, i cynically thought it was something they’d known for a whole and were making public now to distract from the story about his cognitive decline. But having learned more about prostate screening, i no longer think that. I think Biden just got unlucky with this one.
I think we’re going to see a lot of data mined from private health testing in the near future. Regeneron bought the remnants of 23andme for just this reason. Diagnostic MRI scans, glucose trackers, etc. are all going to make use of that data. Hopefully some of it makes it to the public. Or if not, at least contributes to better pharmaceuticals.
No argument there, but I never said otherwise.
That suggests again though that there should not be a hard age cut-off, but that it should be influenced by other test results. If someone naturally has high T levels for their age, maybe they should worry more.
It does look like Canadians and Brits can request a PSA test outside of normal guidance. So possibly this is done already.
Yes, I agree. But only because it’s consistent with normal guidance and thus the most likely scenario. Not because I think they wouldn’t hide inconvenient results.
You can harm a person by “curing” something you mistakenly thought was actually there.
For example, I wouldn’t take ivermectin because I’ve self-diagnosed myself with parasites.
Again - do you actually believe misdiagnoses never happen? That test results are never in error?
The way this works is just that in most or all provinces AFAIK (and certainly in this one) the PSA test as a routine screening procedure for some years now has been deemed not medically necessary, which disqualifies it from coverage under the public health plan. All that means is that if the doctor wants to ask for it, the patient has to pay the lab something like $40. But if the patient has a condition that justifies the test as medically necessary, then it’s fully covered.
On my last visit to the doctor, she noted that I had not had blood work done in a while and prescribed various things to test for, all of which incidentally are covered. She asked if I wanted a PSA test as well and I said no. I didn’t see the point of taking a test that was explicitly not recommended and then likely getting a false positive and being harassed for a biopsy.
Doing a bit more reading, while I’m not too surprised at the high false positive rate of the PSA test (~75% of positives are false), I am fairly surprised that there often aren’t intermediate tests between the PSA and a biopsy. But MRIs can act as a second-level diagnostic and have minimal side effects. Plus with AI it should be cheaper than ever to perform the image analysis.
Maybe MRIs are still considered too expensive. But this would be a fairly short scan.
Hope someone figures this stuff out in the next 5-10 years before it becomes relevant to me…
True. Horses are quite intelligent and sensitive I think.
And test results can be accurate but misleading. The classic is high blood pressure because you are anxious when its measured. You can have high PSA for benign reasons. You can have a thick point on a mammogram due to scarring from a prior physical injury. You can have benign lumps and bumps all over the interior of your body. (Or on your skin, for that matter.)
Exactly, which is why my PCP’s office has a notice on the wall in every examination room that if your BP is over a stated amount upon intake, it will be taken again later in the visit.
The PSA isn’t expensive/invasive surgery. It’s a relatively cheap blood test. Something a Doctor would be expected to run again in the event of a positive result.